Hereditary neuropathy and vocal cord paralysis in a man with childhood diphtheria

We present the case of a 37-year-old Afghani man with a history of childhoo d diphtheria, who was diagnosed with bilateral vocal cord paralysis at age 15 years, At about this time he developed progressive muscular wasting and distally predominant weakness, and subsequently developed respiratory insuf ficiency, necessitating nocturnal ventilatory support. His examination sugg ested a distal symmetric sensorimotor neuropathy, and his brother was simil arly affected, although to a lesser degree. Electromyography (EMG) and nerv e conduction studies revealed this process to be purely axonal. A diagnosis of possible hereditary motor and sensory neuropathy (HMSN) type IIc, hered itary axonal polyneuropathy with vocal cord paralysis, is proposed, althoug h the question of early diphtheritic involvement of the Vocal cords and per ipheral nerves is also considered. (C) 2000 John Wiley & Sons, Inc.